Universal interventions are usually provided by ambulance or hospital staff or the GP.

Universal interventions are what should be given to all children and families immediately following a car crash. These include:

psychological first aid

education

social support

Do not provide the following universal interventions:

psychological debriefing models: there is some evidence that it is of no benefit, and in some cases can lead to poorer outcomes

medication: pharmacotherapy should not be offered as a preventative universal intervention

Psychological first aid

Psychological first aid is generally offered relatively soon after a car crash and can be provided by first responders (eg ambulance) and hospital staff. Psychological first aid is not psychological counselling or debriefing. It involves:

practical care and support helping to address basic needs including safety

listening without any pressure on the child to talk

comforting and helping the child to feel calm

connecting the child with social and emotional support

Education

In many situations, the more informed parents and children are, the better they feel.

The information should be age-appropriate and should include:

common emotional responses, with an emphasis on the changing nature of reactions

likely recovery

effective coping strategies

advice on how to get more help and how to know if further help is needed

Our how to help your child is a great place to start. It explains what children can think, feel or do after an accident and suggests ways parents can help (and where to get extra help if needed).

The After the Injury website is designed for parents, and provides information, tools and resources to support them to help their child to recover from injury.

Social support

Advise parents to seek out social support networks, and to draw on family and friends for comfort and practical assistance.

If the child or adolescent has been screened as high risk, they need to be referred to a mental health practitioner (eg psychologist or psychiatrist) with training and experience working with children, for treatment.

Recommended treatments

Trauma-focused cognitive behavioural therapy is the recommended treatment for children older than 6 years diagnosed with PTSD following a car crash.

Treatment must be tailored to the developmental needs of the child and not be a modified version of an adult treatment.

Parents/caregivers should be involved in therapy, at least initially, and individual therapy is preferred over group therapy.

Treatments to apply with caution

Pharmacotherapy should not be offered as a routine first treatment or adjunct to trauma-focused cognitive behavioural therapy.

Pharmacotherapy may be useful for some children, but this needs to be determined on a case-by-case basis by an appropriately experienced and qualified medical practitioner.

While promising, the effectiveness of eye movement desensitisation and reprocessing for children with PTSD has not yet been reliably established.

For children less than 6 years old

Because the evidence base is not strong, definite recommendations for interventions are not yet possible.

However, this situation is changing with very promising evidence for a specially modified trauma-focussed cognitive behaviour therapy for children aged from 3 to 6 years (Scheeringa et al., 2011).

Attachment-based treatments are generally more applicable and appropriate for the very young.

There is also some good evidence in very young children for child-parent psychotherapy which is a trauma-focussed attachment-based treatment (Lieberman et al., 2005).

Any mental health intervention with young children and infants should be provided by a healthcare provider with specialist training and knowledge beyond that required for school-aged children.